HPV Vaccination and the Risk of Invasive Cervical Cancer

Lei, Jiayao; Ploner, Alexander; Elfström, K. Miriam; Wang, Jiangrong; Roth, Adam; Fang, Fang; Sundström, Karin; Dillner, Joakim; Sparén, Pär

doi:10.1056/nejmoa1917338

Cited by 885 publications

(657 citation statements)

References 34 publications

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“…Among female adolescents, for example, up‐to‐date coverage in 2019 was 57% in the United States 99 compared with 67% in Canada, 100 >80% in Australia (https://ncci.canceraustralia.gov.au/), and >90% in the United Kingdom‐Scotland 98 . In 2020, the first population‐based evaluation of the efficacy of the quadrivalent vaccine for preventing invasive cervical cancer reported adjusted incidence rate ratios of 0.12 (95% CI, 0.00‐0.34) and 0.47 (95% CI, 0.27‐0.75) for women who had been vaccinated before age 17 years and between ages 17 and 30 years, respectively, compared with women who had not been vaccinated 101 …”

Section: Selected Findingsmentioning

confidence: 99%

“…In 2019, up‐to‐date HPV vaccination among adolescents (aged 13‐17 years) ranged from 32% in Mississippi to 78% in Rhode Island among girls and from 29% in Mississippi to 80% in Rhode Island among boys 108 . The HPV vaccine was recently confirmed to reduce the risk of invasive cervical cancer by 88% among women who were inoculated with the quadrivalent vaccine before age 17 years 101 . State/territory differences in other initiatives to improve health, including Medicaid expansion, may also contribute to future geographic disparities 109,110 …”

Section: Selected Findingsmentioning

confidence: 99%

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Cancer Statistics, 2021

Siegel

Miller

Fuchs

et al. 2021

CA A Cancer J Clinicians

13,828

10,557

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Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population‐based cancer occurrence. Incidence data (through 2017) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2018) were collected by the National Center for Health Statistics. In 2021, 1,898,160 new cancer cases and 608,570 cancer deaths are projected to occur in the United States. After increasing for most of the 20th century, the cancer death rate has fallen continuously from its peak in 1991 through 2018, for a total decline of 31%, because of reductions in smoking and improvements in early detection and treatment. This translates to 3.2 million fewer cancer deaths than would have occurred if peak rates had persisted. Long‐term declines in mortality for the 4 leading cancers have halted for prostate cancer and slowed for breast and colorectal cancers, but accelerated for lung cancer, which accounted for almost one‐half of the total mortality decline from 2014 to 2018. The pace of the annual decline in lung cancer mortality doubled from 3.1% during 2009 through 2013 to 5.5% during 2014 through 2018 in men, from 1.8% to 4.4% in women, and from 2.4% to 5% overall. This trend coincides with steady declines in incidence (2.2%‐2.3%) but rapid gains in survival specifically for nonsmall cell lung cancer (NSCLC). For example, NSCLC 2‐year relative survival increased from 34% for persons diagnosed during 2009 through 2010 to 42% during 2015 through 2016, including absolute increases of 5% to 6% for every stage of diagnosis; survival for small cell lung cancer remained at 14% to 15%. Improved treatment accelerated progress against lung cancer and drove a record drop in overall cancer mortality, despite slowing momentum for other common cancers.

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Section: Selected Findingsmentioning

confidence: 99%

Section: Selected Findingsmentioning

confidence: 99%

Cancer Statistics, 2021

Siegel

Miller

Fuchs

et al. 2021

CA A Cancer J Clinicians

13,828

10,557

View full text Add to dashboard Cite

show abstract

“…Licensed prophylactic HPV vaccines have demonstrated high safety (5) and efficacy against persistent HPV infections and precancerous lesions (6), and invasive cervical cancers (7), and HPV vaccination programs have been shown to be cost-effective in a wide range of settings worldwide (8). Furthermore, population-level impact against HPV prevalence and precancerous lesions has been consistently shown in high-income countries (HICs) with wellestablished HPV national vaccination programs (9).…”

mentioning

confidence: 99%

Impact of Human Papillomavirus Vaccination, Rwanda and Bhutan

Baussano¹,

Sayinzoga²,

Tshomo³

et al. 2020

Emerg. Infect. Dis.

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Rwanda and Bhutan, 2 low- and middle-income countries, implemented primarily school-based national human papillomavirus (HPV) vaccination in 2011 (Rwanda) and 2010 (Bhutan). We estimated vaccination effectiveness through urine-based HPV prevalence surveys in schools in 2013–2014 and 2017. In Rwanda, 912 participants from baseline surveys and 1,087 from repeat surveys were included, and in Bhutan, 973 participants from baseline surveys and 909 from repeat surveys were included. The overall effectiveness against vaccine-targeted HPV types (i.e., HPV-6/11/16/18) was 78% (95% CI 51%–90%) in Rwanda, and 88% (6%–99%) in Bhutan and against other α-9 types was 58% (21–78) in Rwanda and 63% (27–82) in Bhutan. No effect against other HPV types was detectable. Prevalence of vaccine-targeted HPV types decreased significantly, as well as that of other α-9 types, suggesting cross-protection. These findings provide direct evidence from low- and middle-income countries of the marked effectiveness of high-coverage school-based, national HPV vaccination programs.

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“…The conclusion from this study was that the increase may be due to insufficient detection of precursor lesions prior to 2009 and the possibility that vaccination may have played a role was dismissed since <0.5% of women in the study cohorts were vaccinated. Indeed a more recent study of vaccination and the risk of cervical cancer in Sweden concluded that vaccinated women aged 30 years or less had a significantly lower risk than unvaccinated women [80]. However, as previously discussed, many studies have now reported vaccine-related herd effects on the transmission of both high-and low-risk HPV types to unvaccinated women, which indicates this could still play a role in the observed increased incidence of cervical cancer.…”

Section: X For Peer Review 13 Of 20mentioning

confidence: 97%

Potential Effects of Human Papillomavirus Type Substitution, Superinfection Exclusion and Latency on the Efficacy of the Current L1 Prophylactic Vaccines

Hampson

Oliver

Hampson

2020

Viruses

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There are >200 different types of human papilloma virus (HPV) of which >51 infect genital epithelium, with ~14 of these classed as high-risk being more commonly associated with cervical cancer. During development of the disease, high-risk types have an increased tendency to develop a truncated non-replicative life cycle, whereas low-risk, non-cancer-associated HPV types are either asymptomatic or cause benign lesions completing their full replicative life cycle. HPVs can also be present as non-replicative so-called “latent” infections and they can also show superinfection exclusion, where cells with pre-existing infections with one type cannot be infected with a different HPV type. Thus, the HPV repertoire and replication status present in an individual can form a complex dynamic meta-community which changes with respect to both time and exposure to different HPV types. In light of these considerations, it is not clear how current prophylactic HPV vaccines will affect this system and the potential for iatrogenic outcomes is discussed in light of recent outcome data.

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HPV Vaccination and the Risk of Invasive Cervical Cancer

Cited by 885 publications

References 34 publications

Cancer Statistics, 2021

Cancer Statistics, 2021

Impact of Human Papillomavirus Vaccination, Rwanda and Bhutan

Potential Effects of Human Papillomavirus Type Substitution, Superinfection Exclusion and Latency on the Efficacy of the Current L1 Prophylactic Vaccines

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